Initial Referral & Enquiry Form

What is a care referral form for?

A referral form captures the first contact about someone who may want your care, whether it comes by phone, email, letter or in person. You start one form for each person during that first call or visit. By the end it shows who the person is, who referred them, what help they want and whether your service can meet their needs.

The form is written for care homes, home care and supported living. You tick your service type at the top and delete the lines meant for the others.

Is it the same as a needs assessment?

No. This form records an enquiry. If the referral goes ahead, you assess the person's needs and preferences together with them, at a separate visit that the form helps you book.

What the form asks

The early sections cover the person, the referrer and whether the person knows about the referral and agrees to it. Then come the reasons for the referral, what matters most to the person, and a tick list of needs from washing and dressing to memory, mental health and outings. There is room for known risks, including any risk to staff or others.

Communication needs get their own section, with formats such as large print, easy read, braille, audio and British Sign Language. The consent section asks whether you have told the person how you will use their information and records any doubt about their capacity to agree. Staff assume a person can make their own decisions unless it is shown they cannot.

Each service type asks a few extra questions:

• Care homes ask about the type of stay wanted and who the person would like to visit them.

• Home care asks about visit times, how staff will get in and any pets or hazards.

• Supported living asks about the tenancy, the housing provider and the hours of support wanted.

Safeguarding and the outcome

If the call raises any worry about abuse or neglect, staff tell the Registered Manager at once, and the form logs any referral to the local authority. The manager then decides whether the needs fit your statement of purpose, books an assessment or records where the person was signposted.

Before you use it, check the needs in Section 4 against the range of needs in your statement of purpose, and add your local authority adult safeguarding number.

A referral that goes ahead moves on to the Assessment of Needs Form. The outcome depends on your Statement of Purpose, and the form prompts you to give the person your Service User Guide or information pack.